Capsule retractor

ABSTRACT

An articular capsule retractor including a flexible construct, a dermal abutting member, and an anchor. The flexible construct includes a strand extending between a first end and a second end. The dermal abutting member is coupled to the flexible construct and is configured to abut a dermal layer. The anchor is coupled to the flexible construct such that the strand extends through a passageway defined by the anchor. Pulling the first end and the second end draws the dermal abutting member and the anchor together.

FIELD

The present disclosure relates to methods and devices for retracting acapsule, such as an articular capsule, during surgery.

BACKGROUND

This section provides background information related to the presentdisclosure which is not necessarily prior art.

An arthroscopic operation on a joint can be difficult because the jointcapsule often inhibits access. For example, it can be difficult toaccess a patient's peripheral compartment during hip arthroscopy.Devices and methods for manipulating the joint capsule to facilitatejoint access, such as during an arthroscopic procedure, would thereforebe desirable.

SUMMARY

This section provides a general summary of the disclosure, and is not acomprehensive disclosure of its full scope or all of its features.

The present teachings provide for an articular capsule retractorincluding a flexible construct, a dermal abutting member, and an anchor.The flexible construct includes a strand extending between a first endand a second end. The dermal abutting member is coupled to the flexibleconstruct and is configured to abut a dermal layer. The anchor iscoupled to the flexible construct such that the strand extends through apassageway defined by the anchor. Pulling the first end and the secondend draws the dermal abutting member and the anchor together.

The present teachings also provide for an articular capsule retractor.The articular capsule retractor includes a flexible construct, ananchor, and a dermal abutting member. The flexible construct includes astrand extending between a first end and a second end. The stranddefines a first adjustable loop and a second adjustable loop. The anchoris coupled to the flexible construct such that at least one of the firstadjustable loop and the second adjustable loop extends through apassageway defined by the anchor. At least one of the first adjustableloop and the second adjustable loop is coupled to the dermal abuttingmember.

The present teachings further provide for a method for retracting andmanipulating an articular capsule comprising: inserting an anchor of anarticular capsule retractor through both a dermal layer and thearticular capsule such that the anchor abuts an inner surface of thearticular capsule on a side of the articular capsule opposite to thedermal layer; arranging a flexible construct such that at least one of afirst end or a second end of a strand thereof passing through the anchoris outside of the dermal layer; and pulling at least one of the firstend or the second end to draw the anchor and the articular capsuletowards the dermal layer, and to manipulate the articular capsule.

Further areas of applicability will become apparent from the descriptionprovided herein. The description and specific examples in this summaryare intended for purposes of illustration only and are not intended tolimit the scope of the present disclosure.

DRAWINGS

The drawings described herein are for illustrative purposes only ofselected embodiments and not all possible implementations, and are notintended to limit the scope of the present disclosure.

FIG. 1 illustrates a capsule retractor according to the presentteachings;

FIG. 2 illustrates the capsule retractor of FIG. 1 being insertedthrough a skin layer and an articular capsule layer;

FIG. 3 illustrates the capsule retractor of FIG. 1, and retraction ofthe articular capsule layer using the capsule retractor;

FIG. 4 illustrates the capsule retractor of FIG. 1, including both afirst anchor and a second anchor, and positioning of the first anchor atan inner surface of the articular capsule layer;

FIG. 5 illustrates positioning of the second anchor at the inner surfaceof the articular capsule layer;

FIG. 6 illustrates the capsule retractor with both the first anchor andthe second anchor at the inner surface of the articular capsule layer,and the first end of a suture construct of the capsule retractorextending beyond an outer surface of the skin layer;

FIG. 7 illustrates retraction of the articular capsule layer against theskin layer upon pulling of the first end of the suture construct to drawthe first anchor and the second anchor against the articular capsulelayer and towards the skin layer;

FIG. 8 illustrates an additional capsule retractor according to thepresent teachings;

FIG. 9 illustrates insertion of the capsule retractor of FIG. 8 at boththe skin layer and the articular capsule layer;

FIG. 10 illustrates retraction of the articular capsule layer againstthe skin layer by pulling first and second ends of a suture construct ofthe capsule retractor of FIG. 8, thus drawing an anchor of the capsuleretractor towards the skin layer;

FIG. 11 illustrates removal of the capsule retractor of FIG. 8 fromwithin the skin layer and the articular capsule layer by pulling aremoval strand of the capsule retractor; and

FIG. 12 illustrates an additional capsule retractor according to thepresent teachings.

Corresponding reference numerals indicate corresponding parts throughoutthe several views of the drawings.

DETAILED DESCRIPTION

Example embodiments will now be described more fully with reference tothe accompanying drawings.

With initial reference to FIGS. 1-3, an articular or joint capsule layeris illustrated at reference numeral 10. The articular capsule layer 10can be any suitable capsule layer, such as a hip capsule layer. Thecapsule layer 10 generally includes an inner surface 12 and an outersurface 14, which is opposite to the inner surface 12. The outer surface14 faces an outer derma layer, such as a skin layer 20. The skin layer20 generally includes an inner surface 22 and an outer surface 24. Theinner surface 22 of the skin layer 20 is opposite to the outer surface14 of the capsule layer 10. The outer surface 24 of the skin layer 20 isopposite to the inner surface 22 of the skin layer 20. The outer surface24 of the skin layer 20 is generally at a patient's exterior. Thecapsule layer 10 can be generally spaced apart from the skin layer 20 inthe natural position of the capsule layer 10 and the skin layer 20, asillustrated in FIGS. 1 and 2 for example.

FIGS. 1-3 further illustrate a capsule retractor according to thepresent teachings at reference numeral 100. The capsule retractor 100generally includes a flexible construct 102, which can be made of anysuitable flexible and elongated material, such as any suitable strand ofmaterial 104. For example, the construct 102 can be a suture construct,and the strand 104 can be a suture strand. Any suitable suture strand104 can be used, such as a braided hollow-core suture. Any suitablebraided suture can be used, such as any of the braided sutures disclosedin U.S. patent application Ser. No. 12/915,962 titled Method andApparatus for Securing Soft Tissue to Bone, which was filed on Oct. 29,2010, published as Publication No. 2011/0098727 on Apr. 28, 2011, isassigned to Biomet Sports Medicine, LLC, and is incorporated byreference herein. The construct 102 and the strand 104 are describedherein as a suture construct 102 and a suture strand 104 for exemplarypurposes only.

The suture strand 104 can include a first end 106 and a second end 108.If the suture strand 104 includes a braided hollow-core suture, thesuture strand 104 can define a passageway extending through a portionof, or an entirety of, the suture strand 104. For example, thepassageway can extend from the first end 106 to the second end 108, oracross any suitable distance between the first end 106 and the secondend 108.

The capsule retractor 100 further includes an anchor 110. The anchor 110can be any suitable anchor, and can be soft and/or flexible, forexample. In place of the anchor 100 or any of the other anchorsdescribed herein, any suitable soft or hard anchor can be used, such asany of the soft or hard anchors described in U.S. application Ser. No.13/098,927 (“'927 application”) titled “Method and Apparatus for SoftTissue Fixation,” filed on May 2, 2011, and assigned to Biomet SportsMedicine, LLC, which is incorporated herein by reference. In place ofthe anchor 100 and any of the other anchors described herein, can alsobe any of the anchors described in U.S. Pat. No. 8,562,647 ('647patent”) titled “Method and Apparatus for Securing Soft Tissue to Bone,”issued on Oct. 22, 2013, and assigned to Biomet Sports Medicine, LLC,which is incorporated herein by reference.

In the example illustrated, the anchor 110 includes a first end 112 anda second end 114, which is opposite to the first end 112. The anchor 110defines an anchor internal passage 116 extending between the first end112 and the second end 114. The anchor 110 is coupled to the sutureconstruct 102 in any suitable manner. For example, the suture strand 104can be threaded through the anchor internal passage 116, such that theanchor 110 is slidably movable along the suture strand 104. The anchor110 can be positioned at any suitable position on the suture strand 104.The anchor 110 can be positioned at any suitable position on the suturestrand 104, such as generally equidistant between the first end 106 andthe second end 108.

FIGS. 1 and 2 further illustrate an inserter 150. The inserter 150 canbe any suitable inserter configured to insert the anchor 110 boththrough the skin layer 20 and the capsule layer 10, such that the anchor110 is positioned at the inner surface 12 of the capsule layer 10. Theinserter 150 is also configured to arrange the capsule retractor 100such that the suture strand 104 extends from the anchor 110 back throughthe capsule layer 10 and the skin layer 20, thereby arranging the firstend 106 and the second end 108 of the suture strand 104 outside of theskin layer 20. For example and as illustrated, the inserter 150 caninclude an elongated tube 152 extending generally between a proximal end154 and a distal end 156 thereof. The elongated tube 152 generallydefines a throughbore 158 extending from a proximal aperture 160 at theproximal end 154, to a distal aperture 162 at the distal end 156. Thethroughbore 158 can define a slit 166 extending along its length toaccommodate the suture strand 104. At the distal end 156 is a pointedtip 164, which is configured to pierce both the skin layer 20 and thecapsule layer 10.

A plunger 180 is configured to cooperate with the inserter 150, andincludes an elongated shaft 182 with a coupling member 184 at a distalend thereof. The elongated shaft 182 is configured to extend through thethroughbore 158, and the coupling member 184 is any suitable couplingmember configured to couple with the anchor 110. For example, thecoupling member 184 can be generally shaped as a fork.

With continued reference to FIGS. 1-3, an exemplary method forpositioning and using the capsule retractor 100 will now be described.With initial reference to FIG. 1, the inserter 150 is first insertedthrough the skin layer 20 and the capsule layer 10. The pointed tip 164at the distal end 156 of the inserter 150 is configured to pierce boththe skin layer 20 and the capsule layer 10. The plunger 180 is thencoupled to the capsule retractor 100, such as by positioning the anchor110 at the coupling member 184 and connecting the anchor 110 to thecoupling member 184. The plunger 180 with the suture construct 102coupled thereto is then inserted through the inserter in order to pushthe anchor 110 through the inserter and position the anchor 110 at theinner surface 12 of the capsule layer 10. Portions of the suture strand104 extending from the anchor 110 are also pushed through the inserter150, but the first end 106 and the second end 108 of the suture strand104 remain outside of the inserter 150.

After the anchor 110 is pushed through the inserter 150, the inserter150 is pulled out of the capsule layer 10 and the skin layer 20, thusleaving the capsule retractor 100 in the position of FIG. 3.Specifically, the anchor 110 is arranged such that it abuts the innersurface 12 of the capsule layer 10, and the suture strand 104 extendsthrough both the capsule layer 10 and the skin layer 20 so that thefirst and second ends 106 and 108 extend beyond the outer surface 24 ofthe skin layer 20.

With additional reference to FIG. 3, the capsule layer 10 is retractedor pulled against the skin layer 20 by pulling the first and second ends106 and 108 of the suture strand 104. Pulling the first and second ends106 and 108 draws the anchor 110 against the inner surface 12 of thecapsule layer 10, changes the shape of the anchor 110 so that it remainsin position, and pulls the capsule layer 10 against the skin layer 20.The capsule layer 10 can be manipulated as desired, such as by asurgeon, by pulling one or both of the first and second ends 106 and108. To retain the capsule layer 10 in a retracted position, such asagainst the skin layer 20 as illustrated in FIG. 3, the suture strand104 can be tied in a knot at the outer surface 24 of the skin layer 20.To remove the capsule retractor 100 out from within the capsule layer 10and the skin layer 20, the capsule retractor 100 can be barely pulledback out through the capsule layer 10 and the skin layer 20.

With additional reference to FIGS. 4-7, the capsule retractor 100 caninclude a plurality of anchors 110, such as a first anchor 110A and asecond anchor 110B. Although the capsule retractor 100 is illustratedand described herein as having two anchors 110A and 110B, the capsuleretractor 100 can have any suitable number of additional anchors 110 aswell. The anchors 110 can be coupled to the suture strand 104 in anysuitable manner. For example, as illustrated in FIGS. 4-7, the first end106 of the suture strand 104 can be a free end, and the second end 108can be secured to or within the second anchor 110B. Therefore, from thefirst end 106, the suture strand 104 extends through the internalpassageway 116B of the second anchor 110B and through the internalpassage 116A of the first anchor 110A. From the first anchor 110A, thesuture strand 104 extends back to the second anchor 110B where thesecond end 108 is secured to the second anchor 110B in any suitablemanner. The anchors 110A and 110B can be provided with the first andsecond anchors 110A and 110B coupled to the suture strand 104 by themanufacturer, or the anchors 110A and 110B, as well as any number ofadditional anchors 110, can be loaded onto the suture strand 104 priorto surgery, such as by using a suitable suture loading device.

Use of the inserter 150 and the plunger 180 to insert the capsuleretractor 100 having a first and second anchor 110A and 110B will now bedescribed. The first anchor 110A is first connected to the plunger 180at the coupling member 184, and then pushed through the throughbore 158of the inserter 150 using the plunger 180. The first anchor 110A ispositioned at the inner surface 12 of the capsule layer 10. The inserter150 and the plunger 180 are then removed out from within the capsulelayer 10 and the skin layer 20.

The second anchor 110B is attached to the coupling member 184, and theinserter 150 is inserted through both the skin layer 20 and the capsulelayer 10 offset from where the first anchor 110A is positioned. Thesecond anchor 110B is then pushed through the inserter 150 and seatedagainst the inner surface 12 of the capsule layer 10 offset from thefirst anchor 110A. The inserter 150 and the plunger 180 are next removedout from within the capsule layer 10 and the skin layer 20.

The suture strand 104 is arranged such that from the first anchor 110Atwo portions of the suture strand 104, each of which extend fromopposite ends of the internal passage 116A, pass back through thecapsule layer 10 and the skin layer 20 to the outer surface 24 of theskin layer 20. From the outer surface 24, the portions of the suturestrand 104 extend back through the skin layer 20 and the capsule layer10 to the second anchor 110B. At the second anchor 110B, one portion ofthe suture strand 104 terminates at the second end 108. The otherportion of the suture strand 104 extends through the internal passage116B from the first end 112B to the second end 114B. From the second end114B, the suture strand 104 extends back through the capsule layer 10and the skin layer 20 to the first end 106, to provide the exemplaryconfiguration of FIG. 6.

The first end 106 can be pulled to move the capsule layer 10 to theretracted position of FIG. 7 in which the capsule layer 10 is movedtowards the skin layer 20, and such that the capsule layer 10 optionallyabuts the skin layer 20. Specifically, as the first end 106 is pulled,the suture strand 104 is pulled through the first and second passageways116A and 116B of the first and second anchors 110A and 110Brespectively. The distance that the suture strand 104 extends betweenthe first and second anchors 110A and 110B is reduced, which causes theanchors 110A and 110B to be pulled against the inner surface 12 of thecapsule layer 10 and towards the skin layer 20, which draws the capsulelayer 10 towards the skin layer 20 in order to retract the capsule layer10. To retain the capsule layer 10 in the retracted position of FIG. 7,the suture strand 104 can be tied in a knot at the outer surface 24 ofthe skin layer 20 proximate to the first end 106.

With reference to FIGS. 8-11, an additional capsule retractor accordingto the present teachings is generally illustrated at reference numeral200. The capsule retractor 200 generally includes a flexible construct202. The flexible construct 202 can be any suitable construct includingan elongated strand, such as a suture strand 204. Although the construct202 is described herein as a suture construct 202, any other suitableconstruct, including any suitable flexible strand or member can be used.The suture strand 204 can be any suitable suture material, such asbraided hollow-core suture. The suture strand 204 can be the same as, orsimilar to, the suture strand 50 described above.

The suture strand 204 generally includes a first end 206 and a secondend 208. A first sleeve 210 and a second sleeve 212 are defined by thesuture strand 204. The suture strand 204 further defines a firstadjustable loop 220 and a second adjustable loop 222 of the sutureconstruct 202. Both the first and second adjustable loops 220 and 222extend between the first sleeve 210 and the second sleeve 212.Specifically, from the first sleeve 210 the suture strand 204 extends toand through the second sleeve 212 to define the first adjustable loop220. From the second sleeve 212, the suture strand 204 extends to andthrough the first sleeve 210 to define the second adjustable loop 222.Extending between the first sleeve 210 and the second sleeve 212, atends thereof opposite to the first and the second adjustable loops 220and 222, is an intermediate portion 230 of the suture strand 204.

The capsule retractor 200 further includes a dermal or skin abuttingmember, which can be any suitable device for abutting the outer surface24 of the dermal or skin layer 20. For example, the dermal or skinabutting member can be a button 240 as illustrated. The button 240generally defines a first aperture 242 and a second aperture 244. Thesuture construct 202 is coupled to the button 240 in any suitablemanner. For example, and as illustrated, the intermediate portion 230extending between the first and second sleeves 210 and 212 extendsthrough and between the first and second apertures 242 and 244.Specifically, from the first sleeve 210, the intermediate portion 230extends through the first aperture 242. From the first aperture 242, theintermediate portion 230 extends to and through the second aperture 244to the second sleeve 212. Thus, the first and second sleeves 210 and 212are generally arranged at a side of the button 240 that is opposite towhere the intermediate portion 230 extends between the first and secondapertures 242 and 244. The first and second sleeves 210 and 212 are alsogenerally arranged on a side of the button 240 opposite to the side ofthe button 240 where the first and second ends 206 and 208 are arranged.Thus, from the first sleeve 210, the suture strand 204 extends throughthe first aperture 242 to the first end 206. From the second sleeve 212,the suture strand 204 extends through the second aperture 244 to thesecond end 208.

The suture construct 202 further includes an anchor 260, which can besimilar to, or the same as, the anchor 110 described above. Therefore,the description of the anchor 110 also applies to the anchor 260. Theanchor 260 generally includes a first end 262 and a second end 264,which is opposite to the first end 262. The anchor 260 defines aninternal passage 266 extending therethrough between the first and secondends 262 and 264. The first adjustable loop 220 and the secondadjustable loop 222 are both arranged such that they extend through theinternal passage 266. Thus, the anchor 260 is slidable along both thefirst adjustable loop 220 and the second adjustable loop 222.

The capsule retractor 200 further includes a removal strand 270. Theremoval strand 270 can be made of any suitable material, such as asuitable suture. The removal strand 270 is coupled to the anchor 260 inany suitable manner. For example, and as illustrated, the removal strand270 extends through the anchor 260, and specifically through braidedstrands of the anchor 260.

With continued reference to FIG. 8, and additional reference to FIG.9-11, use of the capsule retractor 200 to retract capsule layer 10 willnow be described. The anchor 260 is positioned at the inner surface 12of the capsule layer 10 in any suitable manner using any suitableinsertion device. The capsule retractor 200 is positioned such that thefirst and second adjustable loops 220 and 222 extend from the anchor 260through both the capsule layer 10 and the skin layer 20. The button 240is arranged at the outer surface 24 of the skin layer 20. The removalstrand 270 extends from the anchor 260 through the capsule layer 10 andthe skin layer 20.

With reference to FIG. 10, to retract the capsule layer 10 towards andagainst the skin layer 20, the first and second ends 206 and 208 arepulled, which closes both the first adjustable loop 220 and the secondadjustable loop 222. Specifically, pulling the first end 206 pulls thesuture strand 204 through the first sleeve 210, thereby closing thesecond adjustable loop 222. Pulling the second end 208 pulls the suturestrand 204 through the second sleeve 212, thereby closing the firstadjustable loop 220. Tension at the first and the second loops 220 and222 causes the first and the second sleeves 210 and 212 to collapse onthe suture strand 204, thereby locking first and the second adjustableloops 220 and 222 in the closed positions. As the first and secondadjustable loops 220 and 222 close, the anchor 260 is pulled towards thebutton 240, thereby drawing the capsule layer 10 towards and/or to theskin layer 20 in order to retract the capsule layer 10. The button 240remains seated on the outer surface 24 of the skin layer 20, and thusprevents the suture construct 202 from being pulled through the skinlayer 20. With reference to FIG. 11, the capsule retractor 200 can beremoved from the capsule layer 10 and the skin layer 20 in any suitablemanner, such as by pulling the removal strand 270, which will pull theanchor 260 through both the capsule layer 10 and the skin layer 20.

With reference to FIG. 12, an additional capsule retractor according tothe present teachings is generally illustrated at reference numeral 300.The capsule retractor 300 generally includes a flexible construct 302,which can be any suitable construct including an elongated flexiblestrand. For example, the construct 302 can be a suture construct 302.The suture construct 302 can include a suture strand 304, which can beany suitable suture strand, such as a braided hollow-core suture strandsimilar to the suture strands 104 and 204 described above.

The suture strand 304 generally includes a first end 306 and a secondend 308. At the first end 306, the suture strand 304 defines a firstsleeve 310. From the first end 306, the suture strand 304 extendsthrough a first passageway 312 defined by the first sleeve 310 in orderto form a first loop 320.

The suture strand 304 further defines a second sleeve 330 proximate tothe first sleeve 310, and on a side of the first sleeve 310 opposite tothe first loop 320. The second sleeve 330 defines a second passageway332. From the first sleeve 310, the suture strand 304 extends to thesecond sleeve 330 and through the second passageway 332 defined by thesecond sleeve 330 in order to define a second adjustable loop 334 of thesuture construct 302. From the second sleeve 330, the suture strand 304extends to the second end 308.

The capsule retractor 300 further includes an anchor 340, which can be asoft and/or flexible anchor. The anchor 340 can be similar to, or thesame as, the anchors 110 and 260 described above. The anchor 340generally includes a first end 342 and a second end 344. An internalpassage 346 is defined by the anchor 340, and extends between the firstend 342 and the second end 344. The suture strand 304 extends throughthe internal passage 346. The anchor 340 is thus slidably coupled to thesuture strand 304, and is seated on a portion of the suture strand 304defining the second adjustable loop 334.

The capsule retractor 300 further includes a removal strand 350. Theremoval strand 350 generally includes a first end 352 and a second end354. Proximate to the first end 352 is a sleeve 356, which defines apassageway 358. From the first end 352, the removal strand 350 isthreaded through the anchor 340, and through the sleeve 356 to secure toremoval strand 350 to the anchor 340.

The capsule retractor 300 further includes a dermal or skin abuttingmember. Any suitable dermal or skin abutting member can be included,such as a button 370. The button 370 generally defines a plurality ofpassages extending therethrough, such as passages 372, 374, 376, and378. The suture construct 302 is coupled to the button 370 in anysuitable manner. For example, the first loop 320 is coupled to thebutton 370 by way of the passages 372 and 374. Specifically, from thefirst end 306, the suture strand 304 extends through the passage 372,and then back through the button 370 through the passage 374, from whichthe suture strand 304 extends through the first passageway 312. From thesecond sleeve 330, the suture strand 304 extends through the passage 376to the second end 308. The removal strand 350 also passes through thebutton 370, and specifically through the passage 378.

The capsule retractor 300 can generally be arranged at the capsule layer10 and the skin layer 20 in any suitable manner. Specifically, theanchor 340 is inserted through both the skin layer 20 and the capsulelayer 10 using any suitable insertion device, in order to arrange theanchor 340 at the inner surface 12 of the capsule layer 10.

To retract the capsule layer 10 towards and/or to the skin layer 20, thesecond end 308 of the suture strand 304 is pulled in order to close thesecond adjustable loop 334. As the second adjustable loop 334 closes,the anchor 340 is pulled by the suture strand 304 against the innersurface 12 of the capsule layer 10, and towards the skin layer 20 inorder to pull the capsule layer 10 towards the skin layer 20. As thesecond end 308 is pulled, the portion of the suture strand 304 definingthe first loop 320 is pulled through the passageways 372 and 374, whichdraws the first sleeve 310 against the button 370 in order to lock thefirst loop 320 to the button 370. To facilitate retention of the secondadjustable loop 334 in the closed position, and the capsule layer 10 inthe retracted position, the suture strand 304 may be knotted at thebutton 370 proximate to the second end 308, which will prevent thesuture strand 304 from moving back through the passage 376.

The capsule retractor 300 may be removed from cooperation with thecapsule layer 10 and the skin layer 20 in any suitable manner. Forexample, the removal strand 350 can be pulled at the second end 354thereof, which pulls the removal strand 350 through the passageway 378at the button 370, and draws the anchor 340 back through the capsule andskin layers 10 and 20 in the direction of the button 370.

Example embodiments are provided so that this disclosure will bethorough, and will fully convey the scope to those who are skilled inthe art. Numerous specific details are set forth such as examples ofspecific components, devices, and methods, to provide a thoroughunderstanding of embodiments of the present disclosure. It will beapparent to those skilled in the art that specific details need not beemployed, that example embodiments may be embodied in many differentforms and that neither should be construed to limit the scope of thedisclosure. In some example embodiments, well-known processes,well-known device structures, and well-known technologies are notdescribed in detail.

The terminology used herein is for the purpose of describing particularexample embodiments only and is not intended to be limiting. As usedherein, the singular forms “a,” “an,” and “the” may be intended toinclude the plural forms as well, unless the context clearly indicatesotherwise. The terms “comprises,” “comprising,” “including,” and“having,” are inclusive and therefore specify the presence of statedfeatures, integers, steps, operations, elements, and/or components, butdo not preclude the presence or addition of one or more other features,integers, steps, operations, elements, components, and/or groupsthereof. The method steps, processes, and operations described hereinare not to be construed as necessarily requiring their performance inthe particular order discussed or illustrated, unless specificallyidentified as an order of performance. It is also to be understood thatadditional or alternative steps may be employed.

When an element or layer is referred to as being “on,” “engaged to,”“connected to,” or “coupled to” another element or layer, it may bedirectly on, engaged, connected or coupled to the other element orlayer, or intervening elements or layers may be present. In contrast,when an element is referred to as being “directly on,” “directly engagedto,” “directly connected to,” or “directly coupled to” another elementor layer, there may be no intervening elements or layers present. Otherwords used to describe the relationship between elements should beinterpreted in a like fashion (e.g., “between” versus “directlybetween,” “adjacent” versus “directly adjacent,” etc.). As used herein,the term “and/or” includes any and all combinations of one or more ofthe associated listed items.

Although the terms first, second, third, etc. may be used herein todescribe various elements, components, regions, layers and/or sections,these elements, components, regions, layers and/or sections should notbe limited by these terms. These terms may be only used to distinguishone element, component, region, layer or section from another region,layer or section. Terms such as “first,” “second,” and other numericalterms when used herein do not imply a sequence or order unless clearlyindicated by the context. Thus, a first element, component, region,layer or section discussed below could be termed a second element,component, region, layer or section without departing from the teachingsof the example embodiments.

Spatially relative terms, such as “inner,” “outer,” “beneath,” “below,”“lower,” “above,” “upper,” and the like, may be used herein for ease ofdescription to describe one element or feature's relationship to anotherelement(s) or feature(s) as illustrated in the figures. Spatiallyrelative terms may be intended to encompass different orientations ofthe device in use or operation in addition to the orientation depictedin the figures. For example, if the device in the figures is turnedover, elements described as “below” or “beneath” other elements orfeatures would then be oriented “above” the other elements or features.Thus, the example term “below” can encompass both an orientation ofabove and below. The device may be otherwise oriented (rotated 90degrees or at other orientations) and the spatially relative descriptorsused herein interpreted accordingly.

The foregoing description of the embodiments has been provided forpurposes of illustration and description. It is not intended to beexhaustive or to limit the disclosure. Individual elements or featuresof a particular embodiment are generally not limited to that particularembodiment, but, where applicable, are interchangeable and can be usedin a selected embodiment, even if not specifically shown or described.The same may also be varied in many ways. Such variations are not to beregarded as a departure from the disclosure, and all such modificationsare intended to be included within the scope of the disclosure.

What is claimed is:
 1. An articular capsule retractor comprising: aflexible construct including a strand extending between a first end anda second end; a dermal abutting member coupled to the flexible constructand configured to abut a dermal layer; and an anchor coupled to theflexible construct such that the strand extends through a passagewaydefined by the anchor; wherein pulling the first end and the second enddraws the dermal abutting member and the anchor together, and whereinthe flexible construct includes a first sleeve defining a firstpassageway and a second sleeve defining a second passageway, the strandextends through the first passageway to define a first loop, and thestrand extends through the second passageway to define a second loop. 2.The articular capsule retractor of claim 1; wherein the flexibleconstruct is a suture construct and the strand is a suture strand. 3.The articular capsule retractor of claim 1, wherein the anchor isflexible.
 4. The articular capsule retractor of claim 1, wherein theflexible construct extends through an aperture defined by the dermalabutting member.
 5. The articular capsule retractor of claim 4, whereinthe dermal abutting member is a button.
 6. The articular capsuleretractor of claim 1, wherein at least one of the first loop and thesecond loop extends through an aperture defined by the dermal abuttingmember.
 7. The articular capsule retractor of claim 1, wherein both thefirst loop and a second loop extend through an internal passage definedby the anchor.
 8. The articular capsule retractor of claim 1, furthercomprising a removal strand configured to remove the articular capsuleretractor from cooperation with an articular capsule when pulled.
 9. Thearticular capsule retractor of claim 8, wherein the removal strand iscoupled to the anchor.
 10. The articular capsule retractor of claim 9,wherein the removal strand includes a sleeve proximate to an end of theremoval strand, the sleeve defining a passageway through which theremoval strand extends.
 11. The articular capsule retractor of claim 1,wherein the anchor is a first anchor and the passageway defined by thefirst anchor is a first passageway; and wherein the articular capsuleretractor includes a second anchor defining a second passageway; andwherein the strand extends through both the first passageway and thesecond passageway.
 12. A method for retracting and manipulating anarticular capsule comprising: inserting an anchor of an articularcapsule retractor through both a dermal layer and the articular capsulesuch that the anchor abuts an inner surface of the articular capsule ona side of the articular capsule opposite to the dermal layer; arranginga flexible construct such that at least one of a first end or a secondend of a strand thereof passing through the anchor is outside of thedermal layer; and pulling at least one of the first end or the secondend to draw the anchor and the articular capsule towards the dermallayer, and to manipulate the articular capsule.
 13. The method of claim12, further comprising pulling the first end to close a loop of theflexible construct and draw the anchor towards the dermal layer, anddraw a dermal abutting member against an outer surface of the dermallayer.
 14. The method of claim 12, further comprising pulling the firstend to close a first loop of the flexible construct and pulling thesecond end to close a second loop of the flexible construct therebydrawing the anchor towards the dermal layer.
 15. The method of claim 12,further comprising pulling a removal strand coupled to the anchor toremove the articular capsule retractor from cooperation with thearticular capsule and the dermal layer.
 16. A method of moving anarticular capsule comprising: inserting an anchor through a dermal layerand an articular capsule, such that the anchor engages a portion of thearticular capsule; positioning a strand engaged to the anchor so that afirst portion of the strand extends through the articular capsule and isoutside of the capsule; and moving the strand so that the anchor and thearticular capsule moves towards the dermal layer.
 17. The method ofclaim 16, further comprising positioning the strand so that the firstportion thereof extends through the dermal layer and is outside thedermal layer.
 18. The method of claim 16, further comprising passing thestrand through a passage of the anchor.
 19. The method of claim 16,further comprising positioning first and second free ends of the strandoutside of the dermal layer, and moving the first or second free end tocause the anchor and articular capsule to move towards the dermal layer.20. The method of claim 16, further comprising inserting the strandthrough a dermal abutting member positioned outside and adjacent to thedermal layer, and moving the strand so that the anchor and the dermalabutting member move closer together to draw the articular capsuletowards the dermal layer.
 21. The method of claim 20, further comprisingforming a loop with the strand, a first portion of which extends throughthe anchor and a second portion of which extends through the dermalabutting member.
 22. The method of claim 21, further comprisingshortening the loop to draw the anchor towards the dermal abuttingmember.
 23. The method of claim 21, further comprising inserting thestrand through a first sleeve and a second sleeve engaged to the strand.24. The method of claim 21, further comprising withdrawing the anchorout of the articular capsule.
 25. The method of claim 21, wherein theanchor has a flexible body.